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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ----�Ikht__ <br /> Applica-l'icin is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance o. 549. <br /> ---------- <br /> ID L - -----eu....... - - ---- - ------------- --------------- ------------ <br /> JOB ADDRESS AND L CATION—- <br /> 10 ------------- Phone----------------------------------- <br /> --- ------------ ------- ------------ ... ..... <br /> --- - -- - ---- <br /> Owner's Name.._------ <br /> ----------- <br /> -- -----------_--- --------------------------- <br /> -—------------------------tr/_Address---_----------------------------- <br /> Phone----------------------------------- <br /> contractor's Name----------- - ---- ...... -------------------------------------------- ---------- <br /> Installation will serve: Residence Apartment House 0 Commercial ❑ Trailer Court El Motel El Other El <br /> Number of living units: __/___ Number of bedrooms ---�_._ Number of baths ---)--- Lot size <br /> Water Supply: Public system E] Community system E] Private W Depth to Water Table ---------- ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam El Clay Loam E3 Clay E] AdobeHardpan E] <br /> d( <br /> Previous Application Made: Yes E] No� New Construction: Yes 0 No El i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> "from nearest well-319,01- 4istanafrom founda�ion-----Z"0-----Materia--------------------- -------------------------- <br /> Se t' Tank: Distancedepth---------------11 , <br /> Capacity----- - <br /> No. of compartm-'ents----I---- Liquid 0 <br /> PR I -----------Size--A ------Inearest lot line -0 <br /> Disposal Field: Distance from nearest well...�?Vt�2[)isfance from foundation--- -------------- to nearE <br /> El Number of lines------- ---------- ------------gLength of each line-------6.0- - _�t_.Wiclth of trench------ <br /> Type of filter of filter material----_--L—, jotal length___.__ ------------------------- <br /> wel� <br /> Seepage Pit: Distance to nearest ----- ----------------Distance from foundation-------------------Distance to nearest lot line.-_---_.______--. <br /> " ------------------------- <br /> ❑ <br /> Number of pits----------------------Lining material-----------------------Size: Diameter------------------ ----Depth <br /> Cesspool: Distance from 'nearest well-----------------Distance from foundation----------- -------Lining material-__________-._---_.___.-_-__-_-____. <br /> Liq -----il - <br /> Is <br /> D Size: Diameter-------------------------- -----------Depth--------------------------------------__--------- � id Capacity <br /> r 1� y <br /> nearest bu;Jding---------- ---------------------- ------- <br /> -PEvy: Distance from Well-------------------------------------- -----------Distance from <br /> Distance to nearest lot line-------- ---------------- --------------------------------------------I--------I--------------------------------------------------------------- <br /> ❑ <br /> '-----�--��----and/or repairing (describe)--------- ----------76V�------ ---------------------------------------------- ------- ----"----'---•-" <br /> -A--' '!Z..7 � _._a-------- --- ---------------------- <br /> .... .......... - - -------___-------r---- <br /> ------------------------------------------------------------ -------- �2 <br /> —.1Z----- -------------------- ------------------------------------------------- <br /> ---------------------------------------I-------------------- --------­---------------------------- ----------------- ------ -------- ...... <br /> ---------11------------------------------------------------------------------------------------------------------------- ----------- <br /> -------------------------------------------------------------- <br /> I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County <br /> ordinanc9s, State laws.,Pr�da rules and regu�ja *ons of the San Joaquin Local Health District. <br /> -___.-.__(Owner and/or Contractor) <br /> ----- ------ --------------------------- ----------------------- <br /> (Signed)----x <br /> By:------------------------------------------------------------------------------------ --------------------------------I------------(rifle)-------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> I - <br /> - DATE---------- -- <br /> APPLICATION ACCEPTED BY----------------- ---------- ------------ --- -- ---- -—------- <br /> -------b <br /> REVIEWED BY------------------------- -- -- ------- ------ - DATE-.-.- 11-- <br /> BUILDINGISSUED--------- -- -�--------------------------- <br /> - <br /> PERMITISSUED--------------I------------------------- ------------ ----------------- -------------r-------------- DATE---------------------- --------------------------------- <br /> Alterations ar�d/or recommenafio"A's:-------------------------- ......./---- ------------------------------------------------------I--------------__------------------------------------------- <br /> "I -------------------------------------------------------------I---------------------------------------------------- <br /> -----------------------------------------------------------------------I-------------------------------------- ------------------- <br /> ---------------------------------------------------------------------- <br /> -------------------------------------------------- ------- ---------------- ----------------------------- ------------------- <br /> ----------------------------------- --------------------:­-------------- ------ -------------------- -------------­------- ............. ---------------------------------------------- ------------------------------ <br /> ---------------­ --------------- -I-----------------------------------------------------—------------------- <br /> ............ ------------------------------------- ...... .... <br /> ................. -------------- <br /> FINAL INSPECTION BY----------------- -7 --- --------- Date <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West 081 Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9 145446 ATWCUD <br />